World Bank Board Pushes Back on Family Planning

Reuters reported today that World Bank's Executive Board yesterday postponed a decision on a proposed new Health, Nutrition and Population (HNP) strategy in a tussle over words with potentially far-reaching impact. According to the report, the U.S. executive director wanted to amend the strategy to recommend “age appropriate access to sexual and reproductive healthcare" -- language that the Europeans said could restrict younger women's access to contraception and other reproductive services in poor countries.This is the latest twist in a ongoing story that is central to the Bank’s ability to pursue its mission of poverty reduction. Late last week eight members of the Bank’s executive board sent a letter (pdf) scolding Bank management for not giving sufficient attention to family planning and population issues in the draft strategy. In rejecting the draft originally submitted for approval by embattled Bank president Paul Wolfowitz, the eight board members recalled that it is the long-standing policy of the Bank to support the goals of women’s sexual and reproductive health. The revised draft strategy, they said:

“…. makes virtually no reference to sexual and reproductive health, on a strategic level. This is surprising, considering that the Bank has committed almost US$2 billion to sexual and reproductive health over the past 10 years. … The Bank should clearly spell out its commitment to the outcomes of the International Conference on Population and Development (ICPD) and the full Cairo consensus on sexual and reproductive health and rights to guide its work.”

The effort to eliminate most of the “P” (Population) from the HNP strategy reportedly was directed by Juan Jose Daboub , who Wolfowitz named a year ago as one of two new managing directors at the Bank. Daboub, from El Salvador, has been linked in the press to conservative social causes that are out of step with research-based social policy but resonate strongly with some U.S. conservatives.The controversy about the exclusion of family planning is no mere sideshow to the Bank’s current leadership battle. Both those who work within and outside of the Bank see the institution’s position on family planning as a signal of how well it understands that support for family planning and reproductive rights is an essential ingredient of economic growth and improving women's and children’s lives. They worry--as I do--that the Bank's longstanding commitment to pursuing evidence-based policies in health and other areas is under threat.The World Bank has a solid history of support for women’s access to family planning and attention to reproductive health, as called for at the 1996 International Conference on Population and Development in Cairo. This makes sense for an institution dedicated to economic growth and poverty reduction: the relationship between family planning and economic growth is strongly positive, as the Population Reference Bureau (PRB) shows in a newly released datasheet that I developed at PRB before recently joining CGD. The datasheet shows the microeconomic and macroeconomic links between population and economic well-being, reinforcing the importance of having a sound strategy for taking advantage of those links that is well understood by the Bank’s development experts.There is still plenty of work to be done to expand and improve the quality of family planning and reproductive health services, and the Bank is uniquely positioned to contribute. Many millions of women in the developing world lack access to contraception, which limits their economic opportunities, their ability to invest in their children, and even threatens their lives. More than half a million women die each year from maternal causes -- 40 percent of those lives could be saved with increased access to contraception.In pushing back on the HNP strategy yesterday, the Bank’s Executive Board took a stand in favor of the World Bank’s ability to continue to help save the lives of these women, and millions of others who suffer due to lack of access to contraception other reproductive health services that are mostly taken for granted in the rich world. The board has postponed their decision until next week. Many of us will be watching in hopes that the “P” that is restored to the HNP strategy doesn’t stand for patch.